Access to Care in a Medicaid Managed Care World

Each state might look a little different, but Medicaid in all states is moving toward some kind of managed care, stated Matt Salo. And a newly proposed rule from CMS regulating access, enrollment, financing and more is an attempt to get everyone on the same page. But some people are concerned that this rule will stifle innovation in the states, Salo said.

People are appropriately distrustful, though, according to Margaret E. O’Kane, MHA, because it’s a new way of doing things and the success of managed care depends on a “vigorous accountability agenda.”

“There’s going to be a lot of pushback from people that are used to working only in fee-for-service and in a different situation,” she said.

Access to care for Medicaid has been a longstanding issue, Austin Frakt, PhD, said, and it remains a complex one because there are a variety of ways to measure access. The new regulations were concerning, in a way, because he found them vague, and that they put a lot of the burden back on states to put a plan in place for standards to measure access to care without specifying what it should look like.

The National Committee for Quality Assurance will be monitoring the situation, O’Kane said, especially since the industry has been in a period of very broad networks, and now the discussion is about narrow networks.

“It’s kind of a new day for us,” she said.